British Journal of Urology (1997), 79, 279–282 Results of the Mitrofanoff procedure in urinary tract reconstruction in children O. SU ¨ ZER, T.S. VATES, A.L. FREEDMAN, C.A. SMITH and R. GONZALEZ Department of Pediatric Urology, Children’s Hospital of Michigan, Wayne State University, Detroit, Michigan, USA Objectives To evaluate the success and long-term Results Stomal continence was achieved in 42 of 43 patients (98%). The most common late complication complications associated with the use of continent catheterizable conduits based on the Mitrofanoff was difficulty in catheterization, which occurred in 14 patients (32%). Stomal prolapse requiring revision principle in children. Patients and methods The records of 43 patients (21 occurred in one patient (2%). Conduit dilatation was initially attempted in all patients with difficult cath- female and 22 male) who underwent the construction of a continent catheterizable stoma based on the eterization, although it failed in 11 who then required surgical revision. Therefore, the overall revision rate Mitrofanoff principle between 1987 and 1996 were reviewed retrospectively. The mean age at surgery was 28% (12 of 43). The site of stomal placement (umbilical or abdominal) did not significantly influence was 10 years (range 3–21) and the mean follow-up was 3 years (range 0.5–6.5). Twenty-eight of the 43 the risk of difficulty with catheterization. Conclusion The Mitrofanoff procedure can simplify children underwent augmentation cystoplasty in con- junction with the Mitrofanoff procedure, using ileum catheterization in children who are dependent upon intermittent catheterization. The vermiform appendix in 17, sigmoid in seven, caecum in two and stomach in one; detrusormyectomy was performed in one child. appears to be the best source for constructing the conduit. While stomal continence is excellent, conduit Fifteen patients had only a continent catheterizable stoma formed. The most common type of conduit was stenosis remains a frequent complication regardless of stomal location. appendicovesicostomy (36 of 43 children); other con- duits were constructed with ureter (four), tapered Keywords Mitrofanoff principle, complications, urinary tract reconstruction, incontinence ileum (two) and fallopian tube (one). combination with bladder augmentation, and assess Introduction stomal continence and long-term complications. The continent urinary stoma may provide improved access for catheterization when the urethra is inaccess- Patients and methods ible or difficult to catheterize. The Mitrofanoff principle, whereby the appendix or an alternative conduit is The records of 43 patients (21 female and 22 male) who underwent urinary reconstruction based on the implanted in the urinary reservoir in a non-refluxing flap-valve technique, has been instrumental in the Mitrofanoff principle between 1987 and 1996 were reviewed. The mean age of the patients at surgery was success of these conduits. The use of such stomata, par- ticularly in children with severe physical anomalies or 10 years (range 3–21) and the mean follow-up was 3 years (range 0.5–6.5). Most patients had a neurogenic decreased motor skills, may improve accessibility such that clean intermittent catheterization (CIC) can be bladder, PUV or bladder exstrophy (Table 1). Twenty- eight of the 43 children underwent augmentation cysto- performed independently [1]. Herein we report our experience with continent plasty in conjunction with the Mitrofanoff procedure (Table 2) and 15 patients did not require a bladder stomata based on the Mitrofanoff principle, alone or in augmentation. The underlying conditions in these patients included myelodysplasia in five, Prune-Belly Accepted for publication 16 October 1996 syndrome in two, PUV in two, exstrophy in two, Hinman Presented at the 7th annual meeting of the European Society of syndrome in one and three with miscellaneous Paediatric Urology, London, UK, March 1996. conditions. This study was partly supported by the Turkish Scientific and Technologic Research Council (TU ¨ BITAK). 279 © 1997 British Journal of Urology